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Typical Atrial Flutter - When Do You Say You Have Got It

Right atrial flutter (AFL) is a common form of macro reentrant arrhythmia. In absence of previous cardiac surgery, the reentry circuit is usually bounded anteriorly by the tricuspid annulus (TA) and posteriorly by the ostia of vena cava and Eustachian ridge. In this case, AFL is  consensually called  typical”  AFL  and  is  highly dependent  of  the cavotricuspid isthmus (CTI). The CTI is a critical channel which represents the predominant area of slow conduction of the circuit. Therefore, this narrow isthmus has become the universally accepted target for ablation of typical AFL. If ablation is carried out during AFL the first intuitive” procedure endpoint is arrhythmia termination. Although this latter was initially thought to be an acceptable endpoint for ablation procedure, bidirectional CTI conduction block validated 30 minutes after end of ablation, is actually considered as the gold standard endpoint for elimination of typical AFL recurrence. Indeed, Schumacher et al. found a 9% recurrence rate after bidirectional  CTI block achievement, 54% recurrence rate after unidirectional CTI block and 100% recurrence rate when persistent slow conduction across CTI was noted after RF application on the CTI.

Credits: MichaŽl Peyrol, MD; Pascal Sbragia, MD

Biosense Webster
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Introduction to AFib
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